Patient information · Dermatology
Itching all over
itching without a rash is a blood test, not a cream
Itching with a visible rash is usually a skin condition. Itching without any rash — other than scratch marks — is different, and in a meaningful proportion of people it reflects something internal: the liver, kidneys, thyroid, iron stores, or occasionally a blood disorder.
Arrange prompt assessment if itching comes with
- yellowing of the skin or eyes, dark urine or pale stools
- unexplained weight loss, night sweats or fever
- swollen glands lasting more than three weeks
- itching that is worse after a hot bath or shower
- severe itching in pregnancy, particularly on palms and soles
- widespread rash with fever after starting a new medicine
Itching in pregnancy, especially of the palms and soles and worse at night, may be intrahepatic cholestasis of pregnancy, which carries risks to the baby and needs urgent testing. Itching worse after a hot bath is a classic feature of polycythaemia and is worth mentioning specifically.
Internal causes
- Liver disease — particularly conditions blocking bile flow. Often worst on the hands and feet and at night.
- Chronic kidney disease — common in advanced disease, and often generalised.
- Iron deficiency — a recognised and readily treatable cause, even without anaemia.
- Thyroid disease — both over- and underactive.
- Blood disorders — polycythaemia, and lymphoma. Lymphoma-related itch can precede any other sign by months.
- Diabetes, and rarely internal cancers.
- HIV, and parasitic infection in relevant travel history.
Other common causes
- Dry skin — by far the commonest cause overall, particularly in older people and in winter.
- Medicines — opioids, some antibiotics, ACE inhibitors, statins, and many others. Onset can be weeks after starting.
- Scabies — itching far worse at night, often with other household members affected. The burrows can be subtle.
- Menopause, and pregnancy.
- Anxiety and stress, which amplify itch considerably.
- Neuropathic itch — localised, from nerve compression, often on the back or arms.
The scratch-itch cycle
Scratching relieves itch for seconds and worsens it for hours — it releases inflammatory mediators, damages the skin barrier and sensitises nerve endings. Persistent scratching produces thickened, leathery patches (lichenification) and nodules that itch in their own right, so the original cause becomes irrelevant to the current problem. Breaking the cycle is part of the treatment: keep nails short, use cold rather than scratching, and treat at night when scratching is unconscious.
What gets tested
- Full blood count and blood film
- Ferritin and iron studies
- Liver function, including bile acids if pregnant
- Kidney function
- Thyroid function, HbA1c
- Inflammatory markers and LDH
- Chest X-ray and further tests where lymphoma is being considered
- HIV testing where relevant
What helps while the cause is found
Helps
- A thick emollient applied several times a day — the single most useful measure
- Emollient as a soap substitute; stop all soap and shower gel
- Cool or lukewarm showers, kept short, and pat dry
- Keeping the bedroom cool; cotton nightwear and short nails
- Menthol in aqueous cream, which cools and distracts from itch
Makes it worse
- Hot baths and long showers
- Soap, bubble bath and heavily fragranced products
- Wool next to the skin, and overheating at night
- Scratching — press or cool the area instead
- Sedating antihistamines used long term without a diagnosis
Standard non-sedating antihistamines help little in itching without a rash, because histamine is usually not the mediator. That is worth knowing before working through several packets.
Why come to us. Itching without a rash is frequently treated with antihistamines and moisturiser, without anyone checking what is behind it. We examine the skin carefully — including for scabies, which is easily missed — and take the full panel: blood count and film, ferritin, liver, kidney, thyroid, LDH and HbA1c, in-house with results explained the same visit. Where it points to something internal, we arrange imaging or refer promptly. Dermatology available on site, seven days a week.
The bloods that actually explain it
Full panel in-house, results the same visit. Dermatology on site.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.